sustainability and transformation planning · contracts, raps, stabilise bi-lateral – not system...

West Midlands

Sustainability and Transformation

Planning

April 2016 WebEx

1

2

2015-16

Contracts, RAPS,

Bi-lateral – not system

based

Performance

£ overspend

Long term prospects

Rising inequalities

Stabilise

Agree improvement

Improvement Trajectories

core standards –

£ control total

System based controls

Transparency of

QIPP/CIP

System Leadership and

Delivery – model the

future

February – April

stabilise

February – July

plan the future Hit the target

Triple aim gaps targeted

National strategies

prioritised

Value improved

Where are we now

Achieving the 5YFV Vision – the triple aim

1 Health &

Wellbeing Gap

Radical upgrade in

prevention

• National action required on major health risks such as smoking, drinking

and obesity

• Targeted prevention initiatives e.g. diabetes

• Much greater patient awareness

• Harnessing the ‘renewable energy’ of communities

• Address the greatest burdens of ill health by prevention, to close the gap

between life expectancy and healthy life expectancy and reduce health

inequalities

2 Care & Quality

Gap

New Care Models

+ new support

• Defining and measuring quality and tackling unwarranted variation

• A menu of New Care Models for local areas to consider, backed by

investment and flexibility in implementation

• New whole systems intervention regimes to transform local health

economies and raise standards

3 Funding and

Efficiency Gap

Efficiency &

investment

• Action required on three fronts: demand, efficiency and funding

• Action on prevention and care could deliver significant efficiency gains

• The Government has committed to an additional £8.4bn in funding by

2020/21 and, with this investment and implementation of new care models

we believe that we could close the known finance gap

• Build on local NHS and HWBB/partnership work on evidence based

prevention at scale" - this plays to the partnership between LA and NHS.

For the NHS to meet the needs of future patients in a sustainable way, we need to

close all three of these gaps:

3

The NHS Shared Planning Guidance outlined

key, national PH priorities that will need to be

considered in each section

Care and quality gap

• Out of hospital care

• Cancer prevention

• Mental health services

• Dementia services

• Learning disability

• AMR

• Maternity services

• Mental health (incl. CYP)

• Workforce

• Improving commissioning

Finance and efficiency gap

• What savings can be made from “moderating demand growth” e.g. through prevention?

E.g. reducing alcohol consumption can potentially save money via:

a) reduced A&E attendance

b) reduced alcohol related illnesses (liver cirrhosis)

c) reduced anti-social behaviour

d) reduced domestic violence incidences

Health and Wellbeing gap

• Preventable causes of ill health (incl. consumption of alcohol, tobacco)

• Diet and obesity

• Diabetes

• Workforce health

• Patient activation and self-care

Local areas will want to consider these and any other specific locality needs.

The Scale of the Financial Challenge and

Opportunity

5 Years

7 Years

0

0.5

1

1.5

2

2.5

Mar

-14

Jun

-14

Sep

-14

De

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4

Mar

-15

Jun

-15

Sep

-15

De

c-1

5

Mar

-16

Jun

-16

Sep

-16

De

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6

Mar

-17

Jun

-17

Sep

-17

De

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7

Mar

-18

Jun

-18

Sep

-18

De

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8

Mar

-19

Jun

-19

Sep

-19

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9

Mar

-20

Jun

-20

Sep

-20

De

c-2

0

Mar

-21

West Midlands

strategic service change prevention pathway/serviceinnovation provider efficiency financial gap

Max deficit Max deficit Max deficit Max deficit ~

Illustration only

meeting the challenge - a potential scenario

Allocations across Commissioning streams

6

Commissioning 16/17 17/18 18/19 19/20 20/21

CCGs 3.4% 2.1% 2.0% 2.2% 3.8%

Primary Care (GP) 4.2% 4.0% 4.5% 4.8% 5.4%

Other DC -0.6% 0.0% -0.5% -1.2% -1.0%

Specialised Services 7.0% 4.8% 4.5% 4.5% 5.0%

Stability Fund £1.8bn

Transformation Fund £0.4bn £2.9bn £2.9bn £3.4bn £3.4bn

Sustainability funding is allocated to organisations-

but how will it move to systems?

7

• 2016-17

• Birmingham and Solihull £47.1m

• Black Country £40.8m

• Coventry and Warwickshire £27.3m

• Herefordshire and Worcestershire £17.9m

• West Midlands £133.1m

• Fair share by population would be very different £169m

8

(100.00)

(50.00)

-

50.00

100.00

150.00

200.00

250.00

300.00

£fairshare £base Diff 2017-18 2018-19 2019-20 2020-21

West Mids. STP funding

-20

0

20

40

60

80

100

£fairshare £base Diff 2017-18 2018-19 2019-20 2020-21

Birmingham and Solihull 2.62

Blackcountry 2.27

Coventry and Warwickshire 1.52

Hereford and Worcester 0.99

Sustainability

fund

Bridge to

Transformation

Scale of Challenge Requires a New

Leadership Approach

1. Herefordshire and Worcestershire

10

CCGs:

NHS Herefordshire: 188.7k

NHS Redditch and Bromsgrove: 181.3k

NHS South Worcestershire: 296.6k

NHS Wyre Forest: 98.6k

Total Population: 765.2k

Local Government:

Worcestershire County Council

Herefordshire Council

Providers:

Acute

Worcestershire Acute Hospitals NHS Trust

Wye Valley NHS Trust (Acute and Community)

Community

Worcestershire Health and Care NHS Trust

(Community and Mental Health)

Mental Health

2gether NHS FT

Ambulance

West Midlands Ambulance Service NHS FT

System Resilience Groups:

Worcestershire

Herefordshire

Urgent and Emergency Care Network:

West Midlands

Transformation and Vanguards:

Future of Acute Hospitals in Worcestershire

West Midlands NICU

Connecting care

One Herefordshire

Planning lead: Sarah Duggan(Worcestershire Health and

Social Care NHS Trust )

2. Birmingham and Solihull

11

CCGs:

NHS Birmingham South and Central: Pop 205.6k

NHS Solihull: 211.4k

NHS Birmingham Cross City: 743.3k

Total Population: 1,160.3k

Providers:

Acute

Birmingham Children's Hospital NHS FT

Birmingham Women's NHS FT

Heart of England NHS FT

The Royal Orthopaedic Hospital NHS FT

University Hospitals Birmingham NHS FT

Community

Birmingham Community Healthcare NHS Trust

Mental Health

Birmingham & Solihull Mental Health NHS FT

Ambulance



West Midlands

System Resilience Group:

Birmingham and Solihull

Birmingham Children’s

Local Government:

Birmingham City Council

Solihull Metropolitan Council

Planning Lead: Mark Rogers

(CEO Birmingham City Council)


HEFT – Surgical reconfiguration (Paused)

West Midlands NICU review

BSBC Stroke Review

Solihull UEC Vanguard

MERIT –Mental Health Provider

Collaboration Vanguard

3. Coventry and Warwickshire

12

CCGs:

NHS Coventry and Rugby: 445.5k

NHS Warwickshire North: 191.2k

NHS South Warwickshire: 263.8k

Total Population: 900.5k

Providers:

Acute

George Eliot Hospital NHS Trust

South Warwickshire NHS FT (Acute &

Community)

University Hospitals Coventry and

Warwickshire NHS Trust

Mental Health

Coventry and Warwickshire Partnership NHS

Trust (Mental Health & Community)

Ambulance



West Midlands


West Midlands NICU review


Coventry and Rugby

South Warwickshire

Warwickshire North

Local Government :

Warwickshire County Council

Coventry City Council

Planning Lead: Andy Hardy

(CEO - University Hospital Coventry Warwickshire)

4. Black Country

13

CCGs:

NHS Dudley: 316.4k

NHS Sandwell and West Birmingham: 492k

NHS Walsall: 276.2k

NHS Wolverhampton: 253.8k

Total Population: 1,338.4k

Local Authorities:

Birmingham City Council

Dudley Metropolitan Council

Sandwell Metropolitan Council

Walsall Council

Wolverhampton City Council

Providers:

Acute

Sandwell and West Birmingham Hospitals NHS Trust

The Dudley Group NHS FT (Acute & Community)

The Royal Wolverhampton NHS Trust (Acute & Community)

Walsall Healthcare NHS Trust (Acute & Community)

Community

Birmingham Community Healthcare NHS Trust

Black Country Partnership NHS FT

Mental Health

Birmingham and Solihull Mental Health NHS FT

Dudley and Walsall Mental Health Partnership NHS Trust

Ambulance



Dudley

Walsall

Wolverhampton

Sandwell and West Birmingham


West Midlands


West Midlands NICU

Stroke Review

Dudley MCP

Modality MCP

MERIT – Mental Health Collaboration

Planning lead: Andy Williams (Sandwell and West Birmingham CCG)

Transformation Areas

• National commitment to have 20% of population into a fully reformed system

• Being ‘selected nationally’

• May cut across STP’s and natural flows – based on the PMAF, Vanguards – MCP, UEC,

etc.

15

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5 9

10

7

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4

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12

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14

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1

2

2

8

2

5

4

3

5 9

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West Midlands CCGs 1. Walsall CCG 2. Wolverhampton CCG 3. Sandwell & West

Birmingham CCG 4. Dudley CCG 5. Birmingham South &

Central CCG 6. Birmingham Cross City

CCG 7. Redditch & Bromsgrove

CCG 8. Wyre Forest CCG 9. Solihull CCG 10. Warwickshire North CCG 11. Coventry & Rugby CCG 12. South Worcestershire

CCG 13. South Warwickshire 14. Herefordshire CCG

Urgent & Emergency Care Vanguard 1. Solihull Together for Better Lives Acute Care Collaboration Vanguard 2. MERIT 3. National Orthopaedic Alliance

(Orthopaedics specialty franchise) Multispecialty Community Provider Vanguard 4. Vitality (Birmingham and Sandwell) 5. Dudley Multispecialty Community Provider Urgent & Emergency Care Networks 1. Mid Trent Urgent & Emergency Care

Network 2. West Midlands Urgent & Emergency Care

Network

3

Coventry and Warwickshire

Black Country

Birmingham and Solihull

Herefordshire and

Worcestershire

Public Service Reform

Outcomes Quality Value Social value Devolution ‘ask?’

West Midlands Planning Exec

Support across and between

STPs

STP leads, provider CEO, PHE, HEE, NHSI, NHSE, SS, LGA,

Combined Authority Health and Wider Public Services

Connected governance and communication

West Midlands Collective Leadership

• WM STP Executive

• Shared areas for work

– Clinical strategies including specialised (24 March)

– Modelling of Economics and sustainability of proposals

– Workforce strategy to underpin

– Right Care recommended interventions and scale of prevention

– Common growth areas – diagnostics as a work stream

– Exemplar areas and spread of innovation

• Consensus building sessions each month plus a steering group

• How can we use this leadership group more effectively?

• Promote a collective understanding of the HWB gap and the evidence base to

address it

The STP process is split in two: analysis of the

‘gaps’, and development of the action plan to

address these gaps

Stage 1 - By 11 April: scale of challenge, priorities, governance

Stage 2 – from April: Develop STPs and submit for assurance

National guidance and support, events, workshops

• Further guidance (e.g. gap analysis)

• Development days • Programme of

workshops with experts

• Use online tools so local areas can share information and examples of emerging best practice

• Identify the scale of the challenge for each of the three gaps (via ‘gap analysis’)

• Set priorities to address each gap

• Establish the governance arrangements and processes needed to produce and implement STP

• Local partners to develop plans that will address identified challenges and how to close the three gaps over the next five years

• This will include a local prevention plan and a monitoring and evaluation plan (tbc – NHS England)

Dev

elo

pin

g th

e p

lan

Sc

op

ing

the

chal

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‘Initial submission’ for 11 April

‘Final submission’ to RDs on 30 June

After Easter

Develop the plan

• Prevention

• Out of hospital care

• New models

• 7 day services, UEC

• Quality

• National priorities – cancer, MH, LD, Mat

• Achieve financial balance

• Describe enablers – digital roadmap,

workforce, premises

• Engage and enable communities

• Show the bridge from 2016-17

organisational plans to the system plans

National and regional support

• Regional meeting April

• Peer review

• Webinars

• Local support and transfer of knowledge

The Timetable

The most credible and compelling STPs will

secure the earliest funding

• High quality plan: integrated, ambitious, evidenced – does it hang together in words

and numbers

• Reach and quality of local process to develop the plan – how much is the plan ‘owned’

• Strength of partnerships to deliver – confidence in the team

• Clear implementation steps and progress already – credible execution capability

• Tested in July by dragons den?

sustainability and transformation planning · contracts, raps, stabilise bi-lateral – not system...

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